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Can screening tests turn diagnostic? Not unless you were actually diagnosing

02/06/2017

Question: An EKG was ordered as a pre-op screening before cataract surgery, but it revealed a right bundle branch block. What diagnosis code would you choose to submit with the claim for the EKG?

Brief: Office for Civil Rights (OCR) comes out swinging in 2017

02/06/2017

by: Marla Durben Hirsch

OCR has been active in HIPAA compliance so far this year. It entered into its first settlement for missing the 60-day breach notification deadline Jan. 9. Presence Health agreed to pay $475,000 for the company’s failure to notify OCR in a timely fashion.

Brief: CMS updates Open Payments database

02/06/2017

by: Marla Durben Hirsch

CMS on Jan. 17 revised the Open Payments data set to reflect changes to the data. The updates include changes made to records, disputed records and deleted records.

Brief: New rule updates protections for patients in clinical trials

02/06/2017

by: Marla Durben Hirsch

HHS and 15 other departments published a final rule Jan. 19 that revises the protections afforded to individuals participating in medical research, often called the “Common Rule.”

Brief: St. Vincent settles flu shot employee discrimination lawsuit for $300,000

02/06/2017

by: Marla Durben Hirsch

Pennsylvania-based St. Vincent Health Center has agreed to settle a lawsuit brought against it by the Equal Employment Opportunity Commission (EEOC) for $300,000, including back pay and compensatory damages.

Primary diagnosis codes accepted more easily than secondary codes

02/06/2017

by: Roy Edroso

The ICD-10 codes reported most frequently to a major clearinghouse are pretty much what you’d expect — but their denial rates are much worse when they’re claimed as secondary diagnoses than when they’re claimed as the primary.

Clinical Practice Improvement Activities, 2017

01/30/2017

by: Richard Scott

Take a closer look at the clinical practice improvement activities (CPIAs) that you can report for calendar year 2017, the inaugural year of the merit-based incentive payment system (MIPS).

Trump health care order a ‘signal’; Price vague on ACA replacement details in hearings

01/30/2017

by: Roy Edroso

After a bruising hearing before the Senate HELP Committee, President Trump's HHS Secretary nominee, Rep. Tom Price (R.-Ga.), provided mostly general answers to specific questions when grilled Jan. 24 by senators on the Finance Committee, the last stop before the full Senate floor vote on his nomination.

5 tips to succeed with the CPIA category for 2017 MIPS reporting

01/30/2017

by: Richard Scott

Understand how CMS will score the clinical practice improvement activity (CPIA) category under the merit-based incentive payment system (MIPS) and draw up a game plan to easily reach maximum points.

OIG updates guidance for providers about offering gifts to patients

01/30/2017

by: Elizabeth Pearson

OIG's Dec. 7 update should serve as a reminder to practices and other providers of the OIG’s original guidance from 2002 about the rationale for permitting items of nominal value to be provided. It’s also a good opportunity for practices to re-evaluate what the OIG considers appropriate items and services to provide beneficiaries.

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